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Do you participate in any social networking sites (e.g. Facebook, MySpace, LinkedIn)? If so,
please list profile name(s) or web locations:
PRACTICING CHIROPRACTORS ONLY
(Please answer the following questions completely and truthfully. Your answers to the following questions will be kept confidential and is only for use within The Chiropractic Trust )
How do you define straight chiropractic and do you practice that way on a day-to-day basis?
CHIROPRACTIC ASSISTANTS ONLY
As a CA, what would you like to see available or offer as education or training from The Chiropractic Trust?
Terms of Acceptance & Commitment to The Chiropractic Trust
I, , have read, understand and agree that I have completed the above application correctly and truthfully, to the best of my knowledge.
I understand and agree that if accepted for membership, The Chiropractic Trust is
primarily directed at preserving, protecting and promoting the rights and practices of the
non-therapeutic, straight chiropractor without compromise and that my participation in this
organization, or any of its functions, is completely and strictly voluntary and that I may
withdraw as a member at any time for any reason.
I understand and agree to practice in accordance with the Constitution and By-Laws of The
Chiropractic Trust to the best of my ability and I acknowledge that there are certain rights,
benefits and privileges from participating in this organization and those same rights, benefits
and privileges may only be received by my adherence to the same Constitution and By-Laws. I
understand that should I no longer practice in a manner consistent with non-therapeutic,
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straight chiropractic or practice in direct violation of the Constitution and/or By-Laws of The
Chiropractic Trust, as determined by the board, my membership will be subject to
cancellation or may be placed in an alternative and more appropriate membership
classification.
I understand and agree that as part of the rights, benefits and privileges afforded to me by
The Chiropractic Trust, I may be privy to certain information that is proprietary in nature,
copyrighted or otherwise protected, such as but not limited to policies, procedures, seminar
materials, objectives, goals and professional positions and standards designed for or by The
Chiropractic Trust and used to fulfill its missions and objectives. I agree to keep this
information confidential when necessary by not sharing this information with other competing
entities, chiropractic or otherwise, whether or not it is for financial gain.
I understand and agree to act and practice as a professional and conduct myself in a
respectful, moral and ethical manner that is representative of the non-therapeutic, straight
chiropractor and of The Chiropractic Trust.
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I agree to notify the business in writing of any changes in my account information or termination of this authorization 30 days prior to the next due date of the
charges. For ACH debits to my checking/savings account, I understand that because this is an electronic transaction, these funds may be withdrawn from my
account each month as soon as the above noted transaction date. I acknowledge that the origination of ACH transactions to my account must comply with the
provisions of U.S. law. I will not dispute the company’s recurring billing with my bank or credit card company; so long as the transaction corresponds to the terms
indicated in this agreement.